Wednesday, August 22, 2007

Personality 6

R.D. Laing – Another Wounded Healer

Communicating with those diagnosed as Mad 2

Before I continue my thoughts on what sanity and insanity are I should like to say a few words about Dr. Ronald Laing. Suffice it to say that he was a brilliant, if almost totally unorthodox, Scottish psychiatrist. Also he was a conflicted man in himself, hence my reference to his being a wounded healer. But this fact does not lessen him in my estimation – in fact, in a way, it rounds him out as a very real human being who suffered, but also it gave him a great understanding of the patients whom it was his privilege to treat. He was a great and weak human being like many of us. I think, often times, we like to sanitize the lives of our heroes. Which of us can boast a perfect life? We are all really so frail.

Anyway, Ronald Laing was born into a lower middle class family in the Govanhill district of Glascow in 1927, studied medicine at the University of Edinburgh and qualified as a psychiatrist. He wrote extensively on mental illness and particularly on the experience of psychosis or madness which I defined in the last post here on these pages. He is famous for his ideas, influenced primarily by existential philosophy, on the causes and treatment of mental illness, which went against the psychiatric orthodoxy of the time by taking the expressions or communications of the individual patient or client as representing valid descriptions of lived experience or reality rather than as symptoms of some separate or underlying disorder. The WIKI informs us that “he is often associated with the anti-psychiatry movement although, like many of his contemporaries also critical of psychiatry, he himself rejected this label. He made a significant contribution to the ethics of psychology.” (See article on Laing on the WIKI site)

In the course of his life, R.D. Laing moved from the forefront of humane, and humanist, psychiatry to a position of notoriety. Latterly, he was alcoholic, professionally unlicensed, and as disturbed, at times, as anyone he had ever treated. His work also descended into near-madness. Be that as it may, his work from his early and middle years is insightful and truly humanizing and ennobling of his severely ill patients. This last point alone is surely an important reason for never forgetting his contribution to healing the mentally ill. Thankfully, there is a Society for Laingian Studies with an official site at SLS

Laing may be said to have contributed much to what today is called "critical psychiatry.” This latter movement challenges the medical tendency to overly or almost completely scientifically explain away and categorise supposed ‘mentally ill’ behaviour. However, unlike the "anti-psychiatric” movement, it demands recognition and understanding of those who are stigmatised by a psychiatric diagnosis because, for example, they hear voices, or engage in some other behaviour incomprehensible to medical specialists. In many ways, therefore, critical psychiatry continues the project to which Laing contributed so much.

Personally I have known three people who are afflicted with schizophrenia and have tried with varying degrees of success and failure to communicate with them. I attempted to do so and have never nor will I ever regret these efforts. This is a contributing factor to my wishing to study psychotherapy and psychoanalysis when I retire from my teaching career. Anyway, back to my re-reading R.D. Laing’s first book, The Divided Self (Penguin, 1960).

I loved Laing’s simple aim and indeed motivation in this book “to make madness and the process of going mad, comprehensible…to give in plain English an account, in existential terms, of some forms of madness” (op.cit., p. 9) Not alone that Laing took his so called “mad” patients seriously as individuals, worthy of respect and sought to listen to their stories – that is, how life and the experience of life was for them and in them, that is, his emphasis on the word existential, which he italicized in the above quotation. He did not seek to categorize them in any narrow sense which would have been anathema to R. D. L. He also stressed the important role both society and the family had in the process of the patient’s going mad. He has often been criticized for his attribution of a certain amount of causality for madness to the family because of the further guilt-tripping of the family that’s involved here. However, Laing pointed out that the family can in no way be held responsible for this because quite simply they were mostly if not totally unaware of what they were doing to each other. (A contemporary holistic approach to mental health and mental ill-health will incorporate both the findings of standard psychiatry based on psychopharmacology and modern approaches to psychotherapy. I have already alluded to the fact that it is not an either/or scenario but rather a both/and one with respect to the debate (or war in some circles) between the biological approach and the therapeutic one to mental ill-health).

As a good existentialist R.D. Laing was influenced by reading Heidegger, Hesse, Sartre, Merleau-Ponty, Minkowski, Tillich and Bultmann as well as the standard Psychoanalysts. From them he borrowed much of his terminology. One term he favoured was “ontology” which in philosophical circles refers to the study of existence, and in the more esoteric realms of metaphysics would refer to the study of existence or being in itself apart from the nature of any existent object. Needless to say, this latter esoteric (my description of metaphysics with apologies to those who know more than I on the subject) study was not what Laing referred to.

Most of us, according to Laing, experience ourselves as “ontologically secure” and this is how he defines this term: Such a person “will encounter all the hazards of life, social, ethical, spiritual, biological, from a centrally firm sense of his own and other people’s reality and identity.” (ibid., p. 39). Hence, for Laing, the mentally ill experience themselves as “ontologically insecure” as there is no sense of their own or other people’s reality or identity. Therefore, Laing talks about “the primary ontological security” of us so-called mentally healthy or sane individuals in contrast to the “primary ontological insecurity” of the mentally ill or insane. Laing was revolutionary in valuing the content of psychotic behavior and speech as a valid expression of distress, (unlike the great existentialist psychiatrist and philosopher Karl Jaspers who dismissed the patient’s experiences as “un-understandable” and worthy of little consideration), albeit wrapped in an enigmatic language of personal symbolism which is meaningful only from within their situation. According to Laing, if a therapist can better understand his or her patient, the therapist can begin to make sense of the symbolism of the patient's madness, and therefore start addressing the concerns which are the root cause of the distress. Laing engaged, then, with the patient in their “primary ontological insecurity” insofar as this was humanly possible. The WIKI puts it thus: “For Laing, madness could be a trans-formative episode whereby the process of undergoing mental distress was compared to a shamanic journey. The traveler could return from the journey with important insights, and may even have become a wiser and more grounded person as a result.”

In his chapter on “ontological insecurity” Laing refers to literature and the experience of suffering – to Shakespeare, to Keats, to Kafka and to Beckett. While all four spoke about and undoubtedly experienced the evil of suffering in their lives, one can only agree with Laing that both Kafka and Beckett experienced it at a different, perhaps deeper, definitely more alienating a level than the first two. Why? Well for starters both Keats and Shakespeare evil along with a strong sense of personal identity whereas the latter two experienced it without such a sense of personal identity – in fact that sense of personal identity had been stripped away. Hence in these existential works there is despair, there is terror, and there is a gnawing experience of boredom – this last is called anhedonia in psychological circles. Laing even turns to the artistic oeuvre of the modern Irish artist Francis Bacon to depict a similar sense of meaningless to existence.

Laing argues, it would seem, that Shakespeare and Keats experienced some sense of “primary ontological security” whereas our latter two authors might have experienced some sense of “primary ontological insecurity” – namely that they too had some inkling of what it means to be mad or to go mad.

Here is what Laing says about the growing young person: “To anticipate we can say that the individual whose own being is secure in this primary experiential sense, relatedness with others is potentially gratifying; whereas the ontologically insecure person is preoccupied with preserving rather than gratifying himself: the ordinary circumstances of living threaten his low threshold of security.” (ibid., p. 42)

Laing goes on them to discuss three categories of anxiety encountered by the ontologically insecure person. These titles alone are enough to scare us indeed.

1) Engulfment: Laing quotes a patient from an analytic group in hospital: “At best you win an argument. At worst you lose an argument. I am arguing in order to preserve my existence.” The import of this statement cuts me to the quick to say the least, because, thankfully I have never been that low, or so low as to question or even to doubt my “ontological security.” Here the person actually such an “ontological insecurity” that he or she fears that they will lose any sense of self at all – every possible relationship threatens the individual with loss of identity. Reflecting on my own relationships or attempted relationships with the “ontologically insecure” I now know exactly what Laing is getting at and it helps me in retrospect to understand why these individuals withdrew into their own worlds. So engulfment is a high risk for these individuals – a risk in being understood, comprehended, grasped, loved even, because once such happens they are literally identity-less, lost, drowned, engulfed.

2) Implosion: This again is an extremely strong word and Laing acknowledges this. Here the person fears that his/her whole world is about to crash in on them or implode. It is an experience of terror. Laing goes on to point out that his word is again most suitable because the patient feels empty, quite like a vacuum. For the patient his experience is emptiness, is nothingness and the world of the other can and possibly will come crashing in.

3) Petrification and Depersonalization: the first of these words means literally being “turned to stone.” I have an experience of seeing someone thus. This, Laing, points out is the fear of being turned into an “it” rather than a subject or an “I.” I am reminded here of the famous Jewish philosopher Martin Buber who wrote a very interesting and beautiful book called “I-Thou” which I read years ago for philosophy and which I must re-read and review for these pages. Anyway, the truly human and mentally healthy person will have an I-Thou relationship with most significant others. An I=it relationship, needless to say, is a depersonalized relationship, to use Laing’s term. The patient as person feels that he or she will lose their autonomy and all inner life and is totally depersonalized.

One cannot help but notice that the Nazis were adept at making their captives and inmates in their hellish and murderous concentration camps “petrified” and “depersonalized” by the systematic stripping away of every vestige of personality and identity. No wonder, even the strongest physically, intellectually and even morally died. As Frankl so well pointed out only the spiritually or psychically strong survived, that is those who had the strength of spirit (not even character) to find some little (or is it even great?) meaning in sheer absurdity and in the most brutal of hells.

I am left again with the feeling after reading this deep if brutally honest and disturbing chapter that R. D. Laing is much to be thanked for his understanding of the suffering of others. Indeed, with other great human beings whom I have discussed in these pages, I would truly have loved to have met him.

To be continued.


flawedplan said...

Superb, fantastic piece of work. You got right to the heart of it, not many can do that when talking about Laing.

Spiritual Emergency said...

Very good. I enjoyed it immensely. Looking forward to the continuation.

Spiritual Emergency said...

Given the subtitle of your entry (Communicating with those diagnosed as Mad) you may enjoy the following article...

Post-traumatic stress disorder (PTSD) is a psychological condition which may result from experiencing a traumatic event. Experts agree that individuals who suffer from PTSD often communicate using metaphors because it’s difficult to talk about the trauma in literal terms. Since communication about the traumatic event facilitates recovery, we can help individuals recover from trauma by learning to communicate with them using metaphorical language. This principle also applies to individuals experiencing other types of dissociative psychological conditions, such as schizophrenia...

Read the rest of the article here: The Role of Metaphor